Endoscopic retrograde cholangiopancreatography for treatment biliopleural fistulas

Abstract

Background: Biliopleural fistula is a rare communication between the biliary system and the pleural space secondary to ruptured hydatid cysts, hepatobiliary surgeries or penetrating wounds. There is not so much of the subject in the literature, so there is no standardized protocol for its management. Objective: The objective of this work is to determine advantages and disadvantages of the use of ERCP as a conservative initial treatment for biliopleural fistulas. Method: Our retrospective study included patients with a diagnosis of biliopleural fistula who underwent ERCP as initial treatment, older than 18 years in a period from August 2016 to August 2019. Results: Eight patients with a diagnosis of biliopleural fistula were included, 75% men and 25% women with a mean age of 24.5 years; the traumatic etiology was predominant in our group (89%), the diagnosis was made between days 3 and 14 after chest tube placement and we were successful in treating the fistula with ERCP in 87.5% of our patients. Conclusions: The use of ERCP as initial treatment for biliopleural fistula should be considered as the initial tool in the algorithm of management of this entity.

Nonoperative management of grade IV liver laceration following blunt abdominal trauma complicated with delayed bilioplueral fistula

“…3 Bile in the pleural cavity can be damaging to the lungs and pleura due to the corrosive nature of bile and may further worsen the condition of the patient with already compromised physiology due to the initial trauma. 4 This warrants early recognition and prompt management to prevent significant morbidity and mortality.…”